Trazodone
DESYREL
What it isSerotonin antagonist and reuptake inhibitor; licensed for depression, used almost entirely for insomnia.
Why this oneSedating without the dependence liability of a benzodiazepine or z-drug, and it is not a controlled substance.
What limits itOrthostatic hypotension from alpha-1 blockade is the main hazard in the elderly. Priapism is rare but a surgical emergency.
FDA-approved for
- depression (1981)
Off-label
- insomnia
FDA label
Read the full label on DailyMed ↗
| FDA dosing | Population | Start | Target | Max |
|---|---|---|---|---|
| Major depressive disorder | Outpatients | 150 mg/day in divided doses | — | 400 mg/day in divided doses |
| Major depressive disorder | Inpatients (more severe) | 150 mg/day in divided doses | — | 600 mg/day in divided doses |
Titration May increase by 50 mg/day every 3 to 4 days
Renal Undefined
Hepatic Undefined
Instructions
- Take shortly after a meal or light snack
- Swallow whole or break in half along the score line; do not chew or crush
- Taper gradually to discontinue
- Consider dose reduction with strong CYP3A4 inhibitors and dose increase with strong CYP3A4 inducers
- At least 14 days between an MAOI and trazodone in either direction
Contraindications
- MAOIs (concurrently or within 14 days) due to risk of serotonin syndrome
Cautions
- Serotonin syndrome (can occur even alone)
- QT prolongation and cardiac arrhythmias including torsade de pointes
- Orthostatic hypotension and syncope
- Increased risk of bleeding (with NSAIDs/antiplatelets/anticoagulants)
- Priapism
- Activation of mania/hypomania
- Discontinuation syndrome
- Cognitive and motor impairment
- Angle-closure glaucoma
- Hyponatremia/SIADH
Adverse reactions
- Drowsiness
- Dizziness/light-headedness
- Dry mouth
- Blurred vision
- Edema
- Fatigue
- Syncope
- Nausea/vomiting
- Nasal congestion
- Weight change
Pregnancy Published data over decades have not identified drug-associated risks of major birth defects, miscarriage, or adverse outcomes
Lactation Transfers into human milk; limited postmarketing data have not identified adverse effects on the breastfed child
⚠ BOXED WARNING
- Suicidal thoughts and behaviors in patients under 25
Cost, est. cash$4–$80/month
Generic entry1986
Classes and tags
Clinical profile
Legacy pregnancy categoryC
Defining liabilitySedation, orthostasis and priapism; overdose can cause QT prolongation and CNS depression.
Active metabolites
Mechanism of action: Trazodone ballicule
Open Trazodone in the interactive console ↗
Memory aids: mascots and interaction avatars
Polka dots on pink → α1 blocker → syncope if titrated too quickly (hit the floor)
Trazodone is a serotonin antagonist and reuptake inhibitor (SARI)
Bone → risk of priapism
